FCPS Evaluation for Disabilities - does that "get" me anything for insurance purposes?

[Anonymous]

My son is in 3rd grade at FCPS. He has had an IEP since K for speech but is still remarkably behind in language arts/writing and math. I finally have pushed enough that the school has agreed to evaluate him for disabilities (I cannot afford private testing). If he is found to have a disability (and I realize that the school cannot formally "diagnose" him) has anyone been able to leverage that documentation with their insurance company to cover any outside therapy (speech therapy/OT/psychiatrist/etc). We have Cigna if that narrows it down. Thank you!

[Anonymous]

I think if your pediatrician diagnoses him with autism then insurance has to cover ABA and some therapies as in network.

[Anonymous]

Anonymous wrote:I think if your pediatrician diagnoses him with autism then insurance has to cover ABA and some therapies as in network.

Thank you! Do you happen to know if his doctor would take the school's paperwork and use that to formally diagnose him?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think if your pediatrician diagnoses him with autism then insurance has to cover ABA and some therapies as in network.

Thank you! Do you happen to know if his doctor would take the school's paperwork and use that to formally diagnose him?

In my experience, they will use it as part of their own evaluation, but I don’t think they will diagnose based solely on school testing.

[Anonymous]

Cigna paid for our speech and OT for years for our ADHD kid who was diagnosed with ADHD by the pediatrician, but that diagnosis wouldn’t have a direct impact on those two services. And the private speech never looked at the FCPS testing, nor did FCPS ever do OT testing. The private OT and SLP just diagnosed and gave a code and we manually submitted it. We were happy with what Cigna covered, actually.

[Anonymous]

Generally a provider of OT and other therapies can do their own diagnosis for insurance purposes. For all the talk about “neuropsychs” that kind of extensive testing is not actually necessary to get services and get them covered by insurance. The school testing might be helpful in getting started but not necessary. For example if you think your child has fine motor issues you can take them directly to an OT covered by your insurance and they will do the OT assessment. Likewise for therapy or psychiatrist, they will determine a diagnostic code for insurance billing.

The big issue for insurance is whether the service is educational or medical. As I understand it, something like dyslexia is considered educational so would not be covered by insurance (no matter how it is diagnosed). But fine motor skills could be considered medical.

[Anonymous]

No, most school psychologists are credentialed by state education departments. They don't have Ph.D's and licenses to practice privately. Also they are following education code not the DSM.